Invasives Kreislaufmonitoring - Vier Methoden im Vergleich

Zusammenfassung

Der Einfluss der verschiedenen invasiven kardiovaskulären Monitoringverfahren auf Patientensicherheit und -prognose in der perioperativen Medizin ist bis heute nur ungenügend getestet. Daher erscheint es umso wichtiger, diese Verfahren abseits der wenigen gesicherten Indikationen nur nach Abschätzung des individuellen Nutzen-Risiko-Verhältnisses anzuwenden. Die zentralvenöse Sauerstoffsättigung (ScvO₂), deren prognostische Relevanz bei Patienten im septischen Schock gezeigt werden konnte, bietet sich als initialer, wenig invasiver kardiovaskulärer Verlaufsparameter an. Die transpulmonale Thermodilution (z.B. PiCCO-System) ist ein geringinvasives Verfahren, mit dessen Hilfe nicht nur die globale Herzfunktion und der Volumenstatus des Patienten eingeschätzt werden können, sondern das zugleich Informationen über die pulmonalen Auswirkungen der kardiovaskulären Therapie liefert. Die Domäne der geringinvasiven transösophagealen Echokardiographie (TEE) ist neben der Kardioanästhesie die Abklärung der akuten, lebensbedrohlichen hämodynamischen Instabilität. Aufgrund fehlender Wirksamkeit und erhöhter Komplikationsraten wird der invasive Pulmonalarterienkatheter (PAK), abgesehen von Ausnahmeindikationen, zunehmend durch die weniger invasiven Monitoringverfahren ersetzt.

Summary

The impact of invasive hemodynamic monitoring on patient safety and outcome in perioperative medicine remains inadequately tested and unproven. The indications for the use of these tools should, therefore, be evaluated according to an individual risk-benefit analysis. The measurement of central venous oxygen saturation (ScvO₂) is of little invasiveness as most high-risk patients are instrumented with central venous catheters, and ScvO₂ has been shown to improve outcome in patients with septic shock. Transpulmonary thermodilution (e.g. PiCCO-system) delivers information not only on global cardiac function and intravascular volume status but also helps to define the pulmonary consequences of cardiovascular therapy. Transesophageal echocardiography (TEE) is a valuable tool in patients undergoing cardiac surgery and represents the beside-method of choice for rapid assessment of acute life-threatening cardiovascular instability. Apart from special indications, these tools tend to replace the pulmonary artery catheter (PAC) which has been shown to be of little value in various patient populations.

Schlagwörter

Zentralvenöse Sauerstoffsättigung - transpulmonale Thermodilution - Echokardiographie - Pulmonalarterienkatheter - Perioperatives hämodynamisches Monitoring

Keywords

Central venous oxygen saturation - transpulmonary thermodilution - echocardiography - pulmonary artery catheter - perioperative hemodynamic monitoring

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